MEDICARE: RICHARD W DAVIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101044667	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	110164769	OTHER	RR/MED
2	241669	OTHER	BV/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225030091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD W DAVIS M.D.

Provider Business Mailing Address
First Line	:	1627 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3428
Country	:	US
Telephone Number	:	434-517-0611
Fax Number	:	434-572-6675

Provider Business Practice Location Address
First Line	:	1627 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3428
Country	:	US
Telephone Number	:	434-517-0611
Fax Number	:	434-572-6675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/15/2010

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Directions to “ RICHARD W DAVIS M.D.” Practice Location

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